直覺手術 (ISRG) 2022 Q2 法說會逐字稿

Ladies and gentlemen, good afternoon. Thank you for standing by as today's conference assembled. Welcome to the Intuitive Surgical Quarter 2 2022 earnings release. (Operator Instructions) And as a reminder, today's conference is being recorded.

女士們先生們，下午好。感謝您在今天的會議召開時一直待命。歡迎來到 Intuitive Surgical 2022 年第 2 季度收益發布。 （操作員說明）作為提醒，今天的會議正在錄製中。

At this time, it's my pleasure to turn the conference over to our host, Head of Investor Relations with Intuitive Surgical, Mr. Brian King. Please go ahead.

在這個時候，我很高興將會議轉交給我們的主持人，Intuitive Surgical 的投資者關係主管 Brian King 先生。請繼續。

Thank you. So good afternoon, and welcome to Intuitive's Second Quarter Earnings Conference Call. With me today, we have Gary Guthart, our CEO; and Jamie Samath, our CFO.

謝謝你。下午好，歡迎參加 Intuitive 的第二季度收益電話會議。今天和我在一起的是我們的首席執行官 Gary Guthart；和我們的首席財務官 Jamie Samath。

Before we begin, I would like to inform you that comments mentioned on today's call may be deemed to contain forward-looking statements. Actual results may differ materially from those expressed or implied as a result of certain risks and uncertainties. These risks and uncertainties are described in detail in our Securities and Exchange Commission filings, including our most recent Form 10-K filed on February 3, 2022, and Form 10-Q filed on April 22, 2022. Our SEC filings can be found through our website or at the SEC's website. Investors are cautioned not to place undue reliance on such forward-looking statements.

在開始之前，我想通知您，今天電話會議中提到的評論可能被視為包含前瞻性陳述。由於某些風險和不確定性，實際結果可能與明示或暗示的結果大不相同。這些風險和不確定性在我們的證券交易委員會文件中有詳細描述，包括我們於 2022 年 2 月 3 日提交的最新 10-K 表格和 2022 年 4 月 22 日提交的 10-Q 表格。我們的 SEC 文件可以通過我們的網站或 SEC 的網站。告誡投資者不要過分依賴此類前瞻性陳述。

Please note that this conference call will be available for audio replay on our website at intuitive.com on the Events section under our Investor Relations page. Today's press release and supplementary financial data tables have been posted to our website. Today's format will consist of providing you with highlights of our second quarter results as described in our press release announced earlier today, followed by a question-and-answer session. Gary will present the quarter's business and operational highlights, Jamie will provide a review of our financial results, and I will discuss procedure and clinical highlights and provide our updated financial outlook for 2022. And finally, we will host a question-and-answer session.

請注意，本次電話會議將在我們的網站上進行音頻重播，網址為：intuitive.com，位於我們投資者關係頁面下的活動部分。今天的新聞稿和補充財務數據表已發佈到我們的網站。今天的形式將包括為您提供我們今天早些時候宣布的新聞稿中所述的第二季度業績的亮點，然後是問答環節。 Gary 將介紹本季度的業務和運營亮點，Jamie 將回顧我們的財務業績，我將討論程序和臨床亮點，並提供我們對 2022 年的最新財務展望。最後，我們將舉辦問答環節.

And with that, I will turn it over to Gary.

有了這個，我會把它交給加里。

Thank you for joining us today.

感謝您今天加入我們。

Our Q2 results reflect both environmental and Intuitive's specific headwinds accompanied by underlying business strength. Procedures in the quarter grew 14% over last year despite pressure from COVID-driven lockdowns in China, our second largest market. Capital placements slowed from a year ago due to a combination of factors we described last quarter and which I will review shortly. Overall pressure from COVID lockdowns impacted procedures in the quarter modestly while reduced trade-ins and supply chain timing impacted our capital placements more significantly. The leading indicator of the health of our business, procedure demand, remains healthy.

我們的第二季度業績反映了環境和 Intuitive 的特定逆風以及潛在的業務實力。儘管在我們的第二大市場中國受到 COVID 驅動的封鎖的壓力，本季度的程序比去年增長了 14%。由於我們上個季度描述的多種因素，我將很快回顧這些因素，資本配置比一年前有所放緩。 COVID 鎖定的總體壓力對本季度的程序產生了適度的影響，而以舊換新和供應鏈時間的減少對我們的資本配置產生了更大的影響。我們業務健康的領先指標——程序需求保持健康。

Starting first with procedures. I am encouraged by 14% growth in the quarter, reflecting strength in U.S. general surgery and solid growth extending beyond urology outside the United States. U.S. procedure growth was led by bariatric surgery, cholecystectomy and colorectal procedures with continued growth in hernia repair. In OUS markets, procedures grew 22% in the quarter in spite of the COVID lockdown in China.

首先從程序開始。我對本季度 14% 的增長感到鼓舞，這反映了美國普通外科的實力以及超越美國以外泌尿外科的穩健增長。美國手術增長由減肥手術、膽囊切除術和結直腸手術引領，疝修補術持續增長。在 OUS 市場，儘管中國實施了 COVID 封鎖，但本季度的程序增長了 22%。

Outside the U.S., we are seeing strength in urology now accompanied by diversified growth in other procedures. For example, in Japan, growth was strong in general surgery, including rectal resection. In the U.K. and Ireland, growth was strong in gynecology and general surgery. And in France, gynecology and general surgery experienced solid growth. System utilization in several OUS countries has been increasing in recent quarters as procedure adoption diversifies increasing value for our customers and for Intuitive. This is a result of the investments we made in key country markets starting several years ago.

在美國以外，我們看到泌尿科的實力現在伴隨著其他程序的多樣化增長。例如，在日本，包括直腸切除術在內的普通外科手術增長強勁。在英國和愛爾蘭，婦科和普外科增長強勁。在法國，婦科和普外科經歷了穩健的增長。最近幾個季度，隨著程序採用多樣化，我們的客戶和 Intuitive 的價值不斷增加，幾個 OUS 國家/地區的系統利用率一直在增加。這是我們幾年前開始在主要國家市場進行投資的結果。

Turning to da Vinci capital placements. We placed 279 systems in the quarter, down from 328 in Q2 2021. In the da Vinci business, we see 3 causes for the decline in placements relative to a year ago. As our customers have standardized on Generation 4 da Vinci systems, the installed base of third generation systems has declined, lowering the trade-in population, particularly in the United States.

轉向達芬奇資本配售。我們在本季度放置了 279 個系統，低於 2021 年第二季度的 328 個。在達芬奇業務中，我們看到與一年前相比放置下降的 3 個原因。隨著我們的客戶對第 4 代達芬奇系統進行標準化，第三代系統的安裝基礎有所下降，從而降低了以舊換新的數量，尤其是在美國。

Next, supply chain disruption continued in the quarter with semiconductor component delays impacting the timing of system builds, leaving us challenged to match some customer orders at quarter end. Lastly, we've seen hospital capital spending pressure grow in our part of the capital equipment space over the past 2 quarters, incenting customers to seek efficiency gains on existing capital before acquiring new capacity. Component supply constraints remain a risk, and our operating teams are working hard to shelter our customers for most of these pressures.

接下來，供應鏈中斷在本季度繼續存在，半導體組件延遲影響了系統構建的時間，使我們面臨著在季度末匹配一些客戶訂單的挑戰。最後，在過去兩個季度，我們看到醫院資本支出壓力在我們的資本設備領域有所增加，這促使客戶在獲得新產能之前尋求現有資本的效率提升。組件供應限制仍然是一個風險，我們的運營團隊正在努力為我們的客戶提供大部分這些壓力。

Capital placements in more mature markets are a mix of core demand for procedures and trade-in opportunities. The need for high-quality robotic-assisted surgery remains healthy. Incremental capital demand at the customer is a function of system utilization and procedure growth.

在更成熟的市場中進行資本配置是對程序和以舊換新機會的核心需求的混合。對高質量機器人輔助手術的需求仍然健康。客戶的增量資本需求是系統利用率和程序增長的函數。

On the system utilization side, our compound annual growth rate remains at historic levels of 5% over the past 3-year period. System utilization in the U.S. over the past year was slightly down as procedure growth rate over the past year roughly matched the system installed base growth. In contrast, system utilization in many OUS markets, has been rising as procedures diversify. Overall, we prioritize system utilization growth for customers as it increases the value to them of their investments and is aligned with long-term health for Intuitive.

在系統利用率方面，我們過去 3 年的複合年增長率保持在 5% 的歷史水平。過去一年美國的系統利用率略有下降，因為過去一年的程序增長率與系統安裝基數的增長大致匹配。相比之下，隨著程序的多樣化，許多 OUS 市場的系統利用率一直在上升。總體而言，我們優先考慮客戶的系統利用率增長，因為這增加了他們的投資價值，並與 Intuitive 的長期健康保持一致。

Turning to our innovation engines and new products and services, we placed 41 Ion systems, up from 20 in Q2 of last year. Given its stage of maturity, Ion capital demand precedes procedure growth as hospitals seek to build initial capability. With the Ion clinical installed base now at 204 systems, Ion utilization has been growing nicely along with encouraging early capital placements.

談到我們的創新引擎和新產品和服務，我們放置了 41 個 Ion 系統，高於去年第二季度的 20 個。鑑於其成熟階段，隨著醫院尋求建立初始能力，Ion 資本需求先於程序增長。隨著 Ion 臨床安裝基數現在達到 204 個系統，Ion 利用率一直在良好增長，同時鼓勵早期資本配置。

We received 510(k) clearance for our integration of Ion with Siemens Cios Spin cone-beam CT. This combination improves registration and targeting precision for Ion in the lung and is being well received by our customers. We remain focused on strengthening clinical outcomes in lung care, a fantastic customer experience and operational excellence in the Ion program.

我們因將 Ion 與 Siemens Cios Spin 錐形束 CT 集成而獲得了 510(k) 許可。這種組合提高了 Ion 在肺中的配準和靶向精度，並受到我們客戶的好評。我們仍然專注於加強 Ion 計劃的肺部護理臨床結果、出色的客戶體驗和卓越運營。

In our multiport ecosystem, we initiated our first phase U.S. launch of our 8-millimeter stapler designed to work in small anatomical spaces, for example, in thoracic surgery. Early customer feedback has been encouraging. In China, we're preparing to launch our SureForm 45- and 60-millimeter staplers and our latest endoscope, Endoscope Plus. All 3 will continue to support growth in general surgery and thoracic procedures.

在我們的多端口生態系統中，我們在美國啟動了第一階段推出的 8 毫米訂書機，該訂書機設計用於小型解剖空間，例如胸外科。早期的客戶反饋令人鼓舞。在中國，我們正準備推出我們的 SureForm 45 和 60 毫米訂書機以及我們最新的內窺鏡 Endoscope Plus。所有這三個將繼續支持普外科和胸外科手術的增長。

For da Vinci SP, we have expanded the number of colorectal IDE sites to help accelerate accrual and we submitted another regulatory package for SP imaging and accessories in Japan as we work on the necessary clearances to support an SP launch in the country. For our digital tools, Intuitive Hub installs grew nicely again in the quarter, and we're focused on ensuring outstanding customer experiences with data capture and media management, along with increasing utilization over time.

對於 da Vinci SP，我們已經擴大了結直腸 IDE 站點的數量以幫助加速積累，並且我們在日本提交了另一個關於 SP 成像和附件的監管包，因為我們正在努力獲得必要的許可，以支持在該國推出 SP。對於我們的數字工具，Intuitive Hub 的安裝量在本季度再次實現了良好增長，我們專注於通過數據捕獲和媒體管理確保出色的客戶體驗，同時隨著時間的推移提高利用率。

On spending, we are committed to our innovation programs because we believe the forward opportunity for our products and services are important to our customers and to the company. We have some natural shock absorbers that decreased some of our variable spending as a result of the slowdown in da Vinci capital placements. We are also planning for decelerating spend growth after we complete some infrastructure projects we need to support the company's expansion. Given our confidence in the future of our business, we have also returned cash to shareholders in the form of buybacks in the quarter.

在支出方面，我們致力於我們的創新計劃，因為我們相信我們的產品和服務的前瞻性機會對我們的客戶和公司都很重要。由於達芬奇資本配置的放緩，我們有一些天然的減震器，減少了我們的一些可變支出。在完成支持公司擴張所需的一些基礎設施項目後，我們還計劃減緩支出增長。鑑於我們對業務未來的信心，我們還在本季度以回購的形式向股東返還了現金。

I'll now turn the time over to Jamie, who will take you through our finances in greater detail.

我現在將時間交給 Jamie，他將帶您更詳細地了解我們的財務狀況。

Good afternoon. I will describe the highlights of our performance on a non-GAAP or pro forma basis. I will also summarize our GAAP performance later in my prepared remarks. A reconciliation between our pro forma and GAAP results is posted on our website.

下午好。我將在非公認會計原則或備考基礎上描述我們表現的亮點。稍後我還將在準備好的評論中總結我們的 GAAP 表現。我們的備考結果和公認會計原則結果之間的對賬發佈在我們的網站上。

Q2 procedure growth of 14% reflected an increase in U.S. procedures of 11% and OUS procedure growth of 22%. As a reminder, procedures in the U.S. in the second quarter of last year included a recovery of procedures that were delayed as a result of the significant impact of the Omicron variants. Brian will provide additional procedure commentary later in the call.

第二季度程序增長 14% 反映了美國程序增長 11% 和 OUS 程序增長 22%。提醒一下，去年第二季度美國的程序包括恢復由於 Omicron 變體的重大影響而延遲的程序。 Brian 將在稍後的電話會議中提供額外的程序評論。

We placed 279 systems in the second quarter as compared to 328 systems in the second quarter of 2021 and 311 systems last quarter. Q2 system placements were 15% lower than the second quarter of 2021, primarily due to a significant decline in trade-in transactions. There were 56 trade-in transactions in the quarter as compared to 125 in Q2 of 2021, reflecting the decline in the number of SIs remaining in the installed base.

我們在第二季度放置了 279 個系統，而 2021 年第二季度和上一季度分別放置了 328 個系統和 311 個系統。第二季度系統放置比 2021 年第二季度低 15%，主要是由於以舊換新交易顯著下降。本季度有 56 筆以舊換新交易，而 2021 年第二季度為 125 筆，反映出已安裝基礎中剩餘的 SI 數量有所下降。

The supply chain environment continues to be challenging. And during the quarter, we experienced delays in the supply of certain semiconductor components that caused manufacturing output da Vinci systems to be later in the quarter than historical norms. As a result, a number of systems that we would have expected to place in the latter part of June experienced minor delays and were shipped and installed in July.

供應鏈環境仍然充滿挑戰。在本季度，我們遇到了某些半導體組件的供應延遲，導致本季度達芬奇系統的製造產量低於歷史標準。結果，我們原本預計在 6 月下旬安裝的一些系統出現了輕微的延遲，並在 7 月發貨和安裝。

We indicated on last quarter's call that we had experienced a softening in the U.S. capital pipeline. That softness persisted in Q2. Financial pressures have increased on hospitals, given higher inflation, increasing interest rates, supply chain challenges and continued staffing shortages. Some of the larger IDNs have indicated that as a consequence of the financial pressures they face, they are lowering their capital investment plans and tightening operational budgets.

我們在上個季度的電話會議上表示，我們經歷了美國資本管道的疲軟。這種疲軟在第二季度持續存在。鑑於通脹上升、利率上升、供應鏈挑戰和持續的人員短缺，醫院面臨的財務壓力增加。一些較大的 IDN 表示，由於面臨財務壓力，它們正在降低資本投資計劃並收緊運營預算。

We expect that demand for capital, particularly in the U.S., will be impacted while macro conditions remain challenging. Where a particular hospital requires additional da Vinci capacity, given growth in their programs, we will leverage our flexible acquisition models to meet the financial objectives of our customers.

我們預計，在宏觀環境仍然充滿挑戰的情況下，對資本的需求，尤其是在美國，將受到影響。如果某家醫院需要額外的達芬奇產能，鑑於其項目的增長，我們將利用我們靈活的收購模式來滿足客戶的財務目標。

Given the system placements in Q2, the installed base of da Vinci systems grew approximately 13% year-over-year. Utilization of clinical systems in the field, measured by procedures per system, increased approximately 1% compared to last year. Using a 3-year compound annual growth rate, second quarter utilization grew almost 5%, which is in line with historical averages.

考慮到第二季度的系統佈局，達芬奇系統的安裝基數同比增長約 13%。與去年相比，該領域臨床系統的利用率（按每個系統的程序衡量）增加了約 1%。使用 3 年復合年增長率，第二季度利用率增長近 5%，與歷史平均水平一致。

In more mature markets like the U.S., capital demand is sensitive to procedure growth, and therefore, we monitor changes in system utilization closely. As a result of our procedure and capital performance, Q2 revenue was $1.52 billion, an increase of 4% from the second quarter of 2021. On a constant currency basis, second quarter revenue grew approximately 6% over last year. It is worth highlighting that recurring revenue grew 14% year-over-year to $1.24 billion, representing 81% of total revenue.

在美國等更成熟的市場，資本需求對程序增長很敏感，因此我們密切關注系統利用率的變化。由於我們的程序和資本表現，第二季度收入為 15.2 億美元，比 2021 年第二季度增長 4%。按固定匯率計算，第二季度收入比去年增長約 6%。值得強調的是，經常性收入同比增長 14% 至 12.4 億美元，佔總收入的 81%。

Additional revenue statistics and trends are as follows: in the U.S., we placed 150 systems in the second quarter, lower than the 213 in Q2 of 2021, reflecting a decline of 59 systems associated with trade-in transactions, a softer demand environment and the delay of some system placements into July. The remaining installed base of Si Systems in the U.S. is approximately 230 systems.

其他收入統計數據和趨勢如下：在美國，我們在第二季度放置了 150 個系統，低於 2021 年第二季度的 213 個，這反映了與以舊換新交易相關的 59 個系統的減少、需求環境疲軟以及將一些系統展示位置推遲到 7 月。 Si Systems 在美國的剩余安裝基礎約為 230 個系統。

Outside the U.S., we placed 129 systems in the second quarter compared with 115 in the second quarter of 2021. Current quarter system placements included 78 into Europe, 18 into Japan and 15 into China, compared with 63 into Europe, 16 into Japan and 19 into China in the second quarter of 2021. As of the end of Q2 2022, there were 48 systems remaining under the current quota in China, which is also available to competitors that have received local regulatory clearance.

在美國以外，我們在第二季度放置了 129 個系統，而 2021 年第二季度為 115 個。當前季度系統放置包括歐洲 78 個、日本 18 個和中國 15 個，而歐洲 63 個、日本 16 個和 19 個2021 年第二季度進入中國。截至 2022 年第二季度末，中國現有配額內剩餘 48 台系統，也可供已獲得當地監管許可的競爭對手使用。

Globally, trade-in transactions represented 20% of placements in the quarter compared to 38% for full year 2021 and 48% for full year 2020. As we have previously indicated, given the lower number of older generation systems in the field, we expect the volume of trade-ins to be significantly lower in 2022 as compared to last year.

在全球範圍內，以舊換新交易占本季度的 20%，而 2021 年全年為 38%，2020 年全年為 48%。正如我們之前所指出的，鑑於該領域的老一代系統數量較少，我們預計與去年相比，2022 年的以舊換新交易量將顯著降低。

Leasing represented 42% of Q2 placements compared with 35% last quarter and 33% in the second quarter of 2021. The higher lease mix primarily reflected an increase in the proportion of OUS customers that lease the system in the quarter versus purchased, driven in particular by customers in Europe. While leasing will fluctuate from quarter-to-quarter, we continue to expect that the proportion of placements under operating leases will increase over time.

租賃佔第二季度安置的 42%，而上一季度為 35%，2021 年第二季度為 33%。較高的租賃組合主要反映了本季度租賃系統的 OUS 客戶與購買系統的比例增加，特別是推動由歐洲客戶。雖然租賃會隨著季度的變化而波動，但我們仍然預計經營租賃下的配售比例將隨著時間的推移而增加。

Second quarter system average selling prices were $1.50 million, slightly lower than the $1.54 million last quarter. Although system ASPs were roughly flat, lower trading volumes benefit Q2 ASP offset by an unfavorable impact from the stronger U.S. dollar and a higher mix of lower price X systems, primarily driven by customers in Europe.

第二季度系統平均售價為 150 萬美元，略低於上季度的 154 萬美元。儘管系統 ASP 大致持平，但較低的交易量有利於第二季度的 ASP，這被美元走強和較低價格 X 系統組合的不利影響所抵消，主要由歐洲客戶推動。

We recognized $22 million of lease buyout revenue in the second quarter compared with $16 million last quarter and $26 million last year. Lease buyout revenue has varied significantly quarter-to-quarter and will likely continue to do so. Instrument and accessory revenue per procedure was approximately $1,900 per procedure compared with $1,870 last quarter and $1,940 in the second quarter of 2021. The year-over-year decrease primarily reflects the benefit of stocking orders in Q2 of 2021 associated with the launch of our extended use instruments program and an unfavorable FX impact from the stronger U.S. dollar.

我們在第二季度確認了 2200 萬美元的租賃收購收入，而上一季度為 1600 萬美元，去年為 2600 萬美元。租賃收購收入在每個季度之間變化很大，並且可能會繼續如此。每次手術的儀器和附件收入約為 1,900 美元，而上一季度為 1,870 美元，2021 年第二季度為 1,940 美元。同比下降主要反映了 2021 年第二季度與我們的擴展產品的推出相關的庫存訂單的好處使用工具計劃和美元走強帶來的不利外匯影響。

The sequential increase reflects a higher proportion of stapling and advanced energy revenue. Revenue for these categories combined grew 22% as compared to the second quarter of last year. We placed 41 Ion systems in the quarter as compared to 20 Ion placements in the second quarter of last year. The installed base of Ion systems is now 204 systems, of which 90 are under operating lease arrangements.

環比增長反映了主要和先進能源收入的較高比例。與去年第二季度相比，這些類別的總收入增長了 22%。我們在本季度放置了 41 個離子系統，而去年第二季度放置了 20 個離子系統。目前 Ion 系統的安裝基礎為 204 個系統，其中 90 個處於經營租賃協議中。

Second quarter Ion procedures of approximately 5,200 increased 251% compared to the second quarter of 2021. Ion is in the new MDR regulatory review process in Europe and our efforts to pursue a submission in China continue to make progress. Five of the systems placed in the second quarter were SP systems, resulting in an installed base of 111. Second quarter SP procedures grew approximately 28% year-over-year.

第二季度約 5,200 次 Ion 程序與 2021 年第二季度相比增加了 251%。Ion 正在歐洲進行新的 MDR 監管審查程序，我們在中國尋求提交的努力繼續取得進展。第二季度安裝的五個系統是 SP 系統，安裝基數為 111。第二季度 SP 程序同比增長約 28%。

One of the areas of potential clinical differentiation for SP is in narrow access surgery, for example, in transoral robotic surgical or TORS procedures. For malignant TORS procedures, based on the last 4 quarters, we estimate SP market share in the U.S. to be just under 20%. Growth of the SP platform will continue to be gated by additional clinical indications and clearances in markets beyond the U.S. and Korea.

SP 的潛在臨床分化領域之一是狹窄通路手術，例如，經口機器人手術或 TORS 手術。對於惡性 TORS 程序，根據過去 4 個季度，我們估計 SP 在美國的市場份額略低於 20%。 SP 平台的增長將繼續受到美國和韓國以外市場的額外臨床適應症和許可的限制。

Moving on to the rest of the P&L. Pro forma gross margin for the second quarter of 2022 was 69.2% compared with 71.7% for the second quarter of 2021 and 69.8% last quarter. Pro forma gross margin was lower primarily as a result of the stronger U.S. dollar, higher logistics costs, increased component pricing and increased fixed costs relative to revenue as we invest in our infrastructure and manufacturing capacity to serve our long-term needs.

繼續討論損益表的其餘部分。 2022 年第二季度的備考毛利率為 69.2%，而 2021 年第二季度為 71.7%，上一季度為 69.8%。預計毛利率下降主要是由於美元走強、物流成本上升、零部件定價增加以及相對於收入的固定成本增加，因為我們投資於基礎設施和製造能力以滿足我們的長期需求。

Pro forma operating expenses increased 23% compared with the second quarter of 2021. The increase in second quarter operating expenses from a year ago reflected an increase in headcount, higher R&D-related project costs and higher travel costs, including the impact of inflation. Given the early stages of our newer platforms, Ion and SP and our digital ecosystem, we expect to continue to invest in R&D, given the return profile of these investments. Spending in SG&A will be more closely linked to our procedure and revenue performance, and we will continue to pursue plans to invest in infrastructure and business process automation to ensure we can efficiently and effectively scale.

與 2021 年第二季度相比，備考運營費用增加了 23%。第二季度運營費用同比增長反映了員工人數增加、研發相關項目成本增加和差旅成本增加，包括通貨膨脹的影響。鑑於我們的新平台、Ion 和 SP 以及我們的數字生態系統的早期階段，鑑於這些投資的回報情況，我們預計將繼續投資於研發。 SG&A 的支出將與我們的流程和收入績效更緊密地聯繫在一起，我們將繼續實施投資基礎設施和業務流程自動化的計劃，以確保我們能夠有效地擴大規模。

Pro forma operating margin for Q2 was 35% as compared to 40% for the full year 2021. As compared to the second quarter of last year, the net impact of FX, inflation and manufacturing inefficiencies associated with the supply chain environment is a reduction in operating margin of approximately 2%. Our pro forma tax rate -- effective tax rate for the second quarter was 22.3%, in line with our expectations.

第二季度的備考營業利潤率為 35%，而 2021 年全年為 40%。與去年第二季度相比，與供應鏈環境相關的外匯、通貨膨脹和製造效率低下的淨影響是營業利潤率約為 2%。我們的備考稅率——第二季度的有效稅率為 22.3%，符合我們的預期。

Second quarter 2022 pro forma net income was $415 million or $1.14 per share compared with $475 million or $1.30 per share for the second quarter of 2021. Capital expenditures in Q2 were $131 million, primarily comprised of infrastructure investments to expand our facilities footprint, increased manufacturing capacity and automation of certain production lines.

2022 年第二季度備考淨收入為 4.15 億美元或每股 1.14 美元，而 2021 年第二季度為 4.75 億美元或每股 1.30 美元。第二季度的資本支出為 1.31 億美元，主要包括基礎設施投資，以擴大我們的設施足跡，增加製造業某些生產線的產能和自動化程度。

I will now summarize our GAAP results. GAAP net income was $308 million or $0.85 per share for the second quarter of 2022 compared with GAAP net income of $517 million or $1.42 per share for the second quarter of 2021. The adjustments between pro forma and GAAP net income are outlined and quantified on our website and include excess tax benefits associated with employee stock awards, employee stock-based compensation, amortization of intangibles and gains and losses on strategic investments.

我現在將總結我們的 GAAP 結果。 2022 年第二季度的 GAAP 淨收入為 3.08 億美元或每股 0.85 美元，而 2021 年第二季度的 GAAP 淨收入為 5.17 億美元或每股 1.42 美元。備考和 GAAP 淨收入之間的調整在我們的概述和量化網站並包括與員工股票獎勵、員工股票薪酬、無形資產攤銷以及戰略投資損益相關的超額稅收優惠。

We ended the quarter with cash and investments of $8.2 billion compared with $8.4 billion at the end of Q1. The sequential reduction in cash and investments primarily reflected share repurchases and capital expenditures, partially offset by cash from operating activities. Our capital allocation priorities remain consistent and are as follows: first, to organically invest in the business, given the significant opportunities we see to develop differentiated technology and drive adoption of our products. Second, to acquire external technology that creates value for our customers and/or accelerate development time lines or acquisitions that accelerate our growth. Third, we return excess cash to shareholders and look to do so efficiently.

我們在本季度末的現金和投資為 82 億美元，而第一季度末為 84 億美元。現金和投資的連續減少主要反映了股票回購和資本支出，部分被經營活動產生的現金所抵消。我們的資本配置優先事項保持一致，如下所示：首先，鑑於我們看到開發差異化技術和推動產品採用的重大機會，對業務進行有機投資。其次，獲取為我們的客戶創造價值的外部技術和/或加快開發時間線或加速我們增長的收購。第三，我們將多餘的現金返還給股東，並希望能有效地做到這一點。

In Q2, we repurchased 2.2 million of our shares at an average price of $224 per share for a total expenditure of $500 million. Concurrent with today's earnings release, our Board of Directors have improved an increase to the share repurchase authorization to $3.5 billion.

在第二季度，我們以每股 224 美元的平均價格回購了 220 萬股股票，總支出為 5 億美元。在今天發布財報的同時，我們的董事會已將股票回購授權增加到 35 億美元。

And with that, I would like to turn it over to Brian, who will discuss clinical highlights and provide our updated outlook for 2022.

有了這個，我想把它交給布賴恩，他將討論臨床亮點並提供我們對 2022 年的最新展望。

Thank you, Jamie. Our overall second quarter 2022 procedure growth was 14% compared to 68% for the second quarter of 2021, which we believe benefited from a number of procedures which had previously been deferred due to COVID-19. The 3-year compound annual growth rate was 16% between the second quarter of 2019 and second quarter of 2022. In the U.S., second quarter 2022 procedure growth was 11% year-over-year compared to 77% for the second quarter of 2021 and 16% last quarter. On a 3-year compound annual growth basis, U.S. procedure growth was 14%.

謝謝你，傑米。與 2021 年第二季度的 68% 相比，我們 2022 年第二季度的整體程序增長為 14%，我們認為這得益於之前因 COVID-19 而推遲的一些程序。 2019 年第二季度至 2022 年第二季度的 3 年復合年增長率為 16%。在美國，2022 年第二季度的程序增長率為 11%，而 2021 年第二季度為 77%上一季度為 16%。在 3 年復合年增長率的基礎上，美國的手術增長率為 14%。

Q2 procedure growth continued to be driven by general surgery, with particular strength in bariatrics, cholecystectomy and colorectal, while hernia and foregut were also strong contributors. Growth in mature urology and gynecology procedures also continue but at a moderate pace in the low single digits. Outside of the U.S., second quarter procedure volume grew approximately 22% compared with 51% for the second quarter of 2021 and 25% last quarter. Despite COVID-related restrictions in China, on a 3-year compound annual growth basis, procedure growth was 20%.

第二季度手術增長繼續受到普通外科手術的推動，尤其是減肥、膽囊切除術和結直腸手術，而疝氣和前腸手術也有很大的貢獻。成熟的泌尿科和婦科手術也在繼續增長，但速度適中，處於低個位數。在美國以外，與 2021 年第二季度的 51% 和上一季度的 25% 相比，第二季度的手術量增長了約 22%。儘管在中國有與 COVID 相關的限制，但在 3 年復合年增長率的基礎上，程序增長率為 20%。

Turning to Europe. Procedure growth was led by strong growth in Italy, U.K. and Germany. In all 3 regions noted, procedure growth was strong in general surgery and gynecology. In Italy, growth in these procedures outside of urology was led by general surgery, specifically in colorectal and HPV procedures. In Germany, growth in these categories was led by early stage growth in colorectal surgery and benign hysterectomy. Year-over-year procedure growth in these non-neurology procedures was almost 3x higher than urology. While in the U.K., benign hysterectomy and colorectal resection experienced strong early-stage growth.

轉向歐洲。意大利、英國和德國的強勁增長引領了手術增長。在所有 3 個地區，普外科和婦科的手術增長強勁。在意大利，泌尿外科以外的這些手術的增長是由普通外科引起的，特別是在結直腸和 HPV 手術中。在德國，這些類別的增長是由結直腸手術和良性子宮切除術的早期增長帶動的。這些非神經科手術的同比增長幾乎是泌尿科手術的 3 倍。在英國，良性子宮切除術和結直腸切除術經歷了強勁的早期增長。

In Asia, we experienced strong growth in Japan, while in China, procedures remain below expectations as government restrictions continued due to COVID infections that persisted throughout most of the quarter. In Japan, growth in general surgery and gynecology continued to be strong with robust growth, specifically in benign hysterectomy, rectal resection and gastrectomy. In addition, prostatectomy continued with solid double-digit growth, reflecting a recovery when compared to the prior year, which was constrained by COVID. Further contributing to procedure strength was early growth in the adoption of newly reimbursed procedures namely colon resection and nephrectomy procedures.

在亞洲，我們在日本經歷了強勁的增長，而在中國，由於 COVID 感染在本季度的大部分時間裡持續存在政府限制，因此程序仍然低於預期。在日本，普外科和婦科繼續強勁增長，特別是良性子宮切除術、直腸切除術和胃切除術。此外，前列腺切除術繼續以兩位數的穩健增長，與受 COVID 限制的前一年相比有所恢復。進一步促進手術強度的是採用新報銷的手術（即結腸切除術和腎切除術）的早期增長。

In China, second quarter procedure growth continued to be negatively impacted by regional lockdowns due to ongoing COVID infections that affected many large cities throughout most of the quarter. Despite the restrictions, China experienced modest year-over-year growth and began to show signs of a return to normal run rates in June.

在中國，第二季度的手術增長繼續受到區域封鎖的負面影響，原因是持續的 COVID 感染在本季度的大部分時間影響了許多大城市。儘管有這些限制，中國仍經歷了溫和的同比增長，並在 6 月份開始出現恢復正常運行速度的跡象。

Now turning to the clinical side of our business. Each quarter on these calls, we highlight certain recently published studies that we deem to be notable. However, to gain a more complete understanding of the body of evidence, we encourage all stakeholders to thoroughly review the extensive detail of scientific studies that have been published over the years. Earlier this year, Doctors Sarah Diaz and Robert Cleary from St. Joseph Mercy Hospital Ann Arbor, along with Doctors Yongjin Lee and Amir Bastawrous from the Swedish Cancer Institute in Seattle, Washington and in collaboration with Intuitive, published a real-world body of evidence comparing health care utilization outcomes and payer/patient expenditures associated with open and minimally invasive colectomy for benign disease. Notably, this analysis also included a comparison of laparoscopic and da Vinci approaches.

現在轉向我們業務的臨床方面。在這些電話會議的每個季度，我們都會重點介紹我們認為值得注意的某些最近發表的研究。但是，為了更全面地了解證據主體，我們鼓勵所有利益相關者徹底審查多年來發表的科學研究的廣泛細節。今年早些時候，安娜堡聖約瑟夫慈善醫院的 Sarah Diaz 和 Robert Cleary 醫生，以及華盛頓西雅圖瑞典癌症研究所的 Yongjin Lee 和 Amir Bastawrous 醫生與 Intuitive 合作，發表了一份真實世界的證據比較與良性疾病的開放式和微創結腸切除術相關的醫療保健利用結果和付款人/患者支出。值得注意的是，該分析還包括腹腔鏡和達芬奇方法的比較。

Utilizing the IBM MarketScan commercial claims and encounter database, this study included over 10,000 adult patients who between January 2013 and December 2018 underwent an elective inpatient colectomy for a benign condition with over 2,500 patients in the open group and over 6,000 subjects in the laparoscopic group and over 1,000 patients in the da Vinci Group. Through an inverse propensity treatment weighted analysis, the minimally invasive approach demonstrated a lower total health care expenditure across all time frames analyzed from the surgical procedure through 365 days post procedure, with lower average total expenditures ranging from $2,300 to $8,100.

利用 IBM MarketScan 商業索賠和遭遇數據庫，本研究包括 10,000 多名成人患者，他們在 2013 年 1 月至 2018 年 12 月期間因良性疾病接受了選擇性住院結腸切除術，其中開放組有 2,500 多名患者，腹腔鏡組有 6,000 多名受試者，以及達芬奇集團的 1,000 多名患者。通過逆向傾向治療加權分析，微創方法顯示從外科手術到術後 365 天分析的所有時間範圍內的總醫療保健支出較低，平均總支出較低，從 2,300 美元到 8,100 美元不等。

With regards to resource utilization, the minimally invasive approach demonstrated an approximately 2-day lower length of stay with these patients less likely to be readmitted, visit the emergency department or visit the outpatient department within 365 days from the procedure. The reduction in health care use among minimally invasive patients translated to an additional savings over $5,700 and over 2 fewer days missed from work for health care visits.

在資源利用方面，微創方法顯示這些患者的住院時間縮短了大約 2 天，這些患者不太可能在手術後 365 天內再次入院、去急診科或門診就診。微創患者的醫療保健使用減少轉化為額外節省超過 5,700 美元，並且因醫療保健就診而缺勤的天數減少了 2 天。

Within the MIS category when comparing laparoscopic and da Vinci approaches, da Vinci had a 70% lower risk of conversion to open with over a half day shorter length of stay and patients were less likely to have an outpatient hospital visit within 1 year of the procedure. Of note, patients who had a conversion to open had a longer length of stay, higher hospital payments and were more likely to have a readmission for hospital visit within 1 year of the procedure. The reduction in conversion is translated to an additional savings of approximately $4,800 and 1.5 fewer days of missed work due to health care visits.

在 MIS 類別中，當比較腹腔鏡和達芬奇方法時，達芬奇的轉開放風險降低了 70%，住院時間縮短了半天以上，患者在手術後 1 年內就診的可能性更低.值得注意的是，轉為開放式的患者住院時間更長，住院費用更高，並且更有可能在手術後 1 年內再次入院。轉換率的降低轉化為額外節省了大約 4,800 美元，並且因就醫而缺勤的天數減少了 1.5 天。

The authors concluded in part that minimally invasive colectomy is associated with lower mean health care expenditures and less mean health care resource utilization compared to the open approach for benign disease, with a shorter mean length of stay and conversion to open rate observed with the da Vinci approach.

作者部分得出結論，與良性疾病的開放式方法相比，微創結腸切除術與較低的平均醫療保健支出和較少的平均醫療保健資源利用率相關，達芬奇觀察到的平均住院時間和轉換為開放率的時間較短方法。

I will now turn to our financial outlook for 2022. Starting with procedures. On our last call, we forecast full year 2022 procedure growth within a range of 12% to 16%. We are now increasing our forecast and expect full year 2022 procedure growth of 14% to 16.5%. This range continues to reflect the uncertainty associated with the course of the pandemic. The low end of the range assumes increasing COVID hospitalization and staffing pressure at hospitals for the remainder of the year. At the high end of the range, we assume COVID-19-related hospitalizations around the world continue to decline throughout the remainder of 2022, and there are no additional significant impacts from further resurgences. The range does not reflect significant material supply chain disruptions or hospital capacity constraints similar to what we experienced at the start of the pandemic.

我現在將轉向我們對 2022 年的財務展望。從程序開始。在我們上次的電話會議上，我們預測 2022 年全年的程序增長在 12% 至 16% 的範圍內。我們現在正在提高我們的預測，並預計 2022 年全年手術增長 14% 至 16.5%。該範圍繼續反映與大流行病程相關的不確定性。該範圍的低端假設在今年剩餘時間裡，醫院的 COVID 住院和人員壓力增加。在該範圍的高端，我們假設全球與 COVID-19 相關的住院人數在 2022 年剩餘時間內繼續下降，並且進一步復甦不會產生額外的重大影響。該範圍並未反映出與我們在大流行開始時所經歷的情況類似的重大材料供應鏈中斷或醫院容量限制。

While procedure growth so far in the first half of 2022 has been healthy, the capital pipeline in the U.S. has been softer than in prior periods, mainly due to a lower number of Si Systems in the installed base available for trade-in and macro-related headwinds creating pressure on the hospital capital spending. Capital placements in more mature markets are a function of procedure demand that is moderated by system utilization growth and trade-in opportunities.

雖然到目前為止，2022 年上半年的程序增長一直很健康，但美國的資本管道比以往時期要疲軟，這主要是由於可用於以舊換新和宏觀調控的已安裝矽系統數量減少。相關不利因素對醫院資本支出造成壓力。更成熟市場的資本配置是程序需求的函數，受系統利用率增長和以舊換新機會的影響。

While trade-in opportunities have declined, the core demand for procedures continues to be healthy and system utilization has been increasing. With a 3-year compound annual growth rate in procedures of 16% from Q2 of 2019 to Q2 of 2022 and installed base growth of 11% over the same period, utilization of installed systems has continued to increase through the pandemic and first half of 2022. This is increasing the value derived from the existing installed base for our customers and for us. As we look ahead, we expect these capital dynamics to continue for the foreseeable future.

雖然以舊換新的機會有所減少，但對程序的核心需求繼續保持健康，系統利用率一直在增加。從 2019 年第二季度到 2022 年第二季度，程序的 3 年復合年增長率為 16%，安裝基數同期增長 11%，已安裝系統的利用率在大流行和 2022 年上半年持續增加. 這為我們的客戶和我們增加了從現有安裝基礎中獲得的價值。展望未來，我們預計這些資本動力將在可預見的未來繼續存在。

Turning to gross profit. On our last call, we forecast our 2022 full year pro forma gross profit margin to be within 69% and 70.5%. We are now refining our estimate of pro forma gross profit margin to be within 69% and 70% of net revenue. Given the ongoing impact of higher input costs related to supply chain and the impact from a stronger U.S. dollar, we would expect to be towards the lower end of that range. Our actual gross profit margin will vary quarter-to-quarter depending largely on product, regional and trading mix, fluctuations in foreign currency rates and the impact of new product introductions.

轉向毛利。在我們上次的電話會議上，我們預測我們 2022 年全年的備考毛利率將在 69% 和 70.5% 之間。我們現在正在改進我們對備考毛利率的估計，使其在淨收入的 69% 和 70% 以內。鑑於與供應鏈相關的較高投入成本的持續影響以及美元走強的影響，我們預計將接近該範圍的下限。我們的實際毛利率將因產品、地區和貿易組合、外匯匯率波動以及新產品推出的影響而異。

With respect to operating expenses, on our last call, we forecast pro forma operating expense growth to be between 23% and 27%. We are refining our estimate and now expect our full year pro forma operating expense growth to be between 23% and 25%. We are refining our estimate for noncash stock compensation expense to range between $520 million to $540 million in 2022. We are also refining our estimate for other income, which is comprised mostly of interest income, to total between $60 million and $70 million in 2022, an increase from our previous estimate of $50 million and $60 million. The increase primarily reflects the continued rise in interest rates.

關於運營費用，在上次電話會議上，我們預測備考運營費用增長將在 23% 至 27% 之間。我們正在完善我們的估計，現在預計我們全年的備考運營費用增長將在 23% 至 25% 之間。我們正在改進對 2022 年非現金股票補償費用的估計，將其估計在 5.2 億美元至 5.4 億美元之間。我們還將對主要包括利息收入的其他收入的估計進行改進，到 2022 年總計在 6000 萬美元至 7000 萬美元之間，比我們之前估計的 5000 萬美元和 6000 萬美元有所增加。這一增長主要反映了利率的持續上升。

On last quarter's call, we forecast 2022 capital expenditures within a range of $700 million to $900 million. We are now refining estimated capital expenditures for 2022 to be in the range of $700 million to $800 million. With regard to income tax, we continue to estimate our 2022 pro forma tax rate to be between 22% and 24% of pretax income.

在上一季度的電話會議上，我們預測 2022 年的資本支出在 7 億美元至 9 億美元之間。我們現在正在將 2022 年的估計資本支出調整為 7 億至 8 億美元。關於所得稅，我們繼續估計我們 2022 年的備考稅率將在稅前收入的 22% 至 24% 之間。

That concludes our prepared comments. We will now open the call to your questions.

我們準備好的評論到此結束。我們現在將打開您的問題的電話。

(Operator Instructions) And we're going to begin today with Larry Biegelsen representing Wells Fargo.

（操作員說明）今天我們將從代表富國銀行的拉里·比格爾森開始。

Gary, maybe if I could start with the supply constraints that you talked about, could you quantify how much you think that negatively impacted Q2? It sounds like they've been resolved. And Gary, obviously, people are worried about the impact of a recession. How are you better positioned this time compared to the last recession we saw in 2008, 2009? And I have one follow-up.

加里，如果我可以從您談到的供應限制開始，您能否量化您認為對第二季度產生的負面影響？聽起來他們已經解決了。加里，顯然，人們擔心經濟衰退的影響。與我們在 2008 年和 2009 年看到的上一次經濟衰退相比，您這次的定位如何？我有一個後續行動。

Okay. On the supply constraint side, I'll give you a qualitative perspective and Jamie, you can fill in a little bit of a quantitative perspective. What's happening is semiconductor suppliers and some other raw material suppliers giving us choppy delivery time lines, so estimates that are sometimes moving around, and that can bring product in late in the quarter. When we assemble that product, it can sometimes make it hard at very quarter end to match system configurations to customers and that's largely what happened in Q2. Jamie, you want to add to that?

好的。在供應限制方面，我會給你一個定性的觀點，傑米，你可以填寫一點定量的觀點。正在發生的事情是半導體供應商和其他一些原材料供應商給了我們不穩定的交貨時間線，因此估計有時會發生變化，這可能會在本季度末帶來產品。當我們組裝該產品時，有時很難在季度末將系統配置與客戶匹配，這主要是在第二季度發生的情況。傑米，你想補充一下嗎？

Think about the impact to Q2 placements roughly in the 5%-ish range in terms of without those supply constraints, those delayed semiconductor components the incremental systems that would have been delivered in Q2.

在沒有這些供應限制的情況下，考慮到對第二季度佈局的影響，大約在 5% 左右的範圍內，那些延遲的半導體組件將在第二季度交付的增量系統。

That continues to be choppy, and we expect, certainly for Q3 and perhaps forward that we'll continue to fight those fights in terms of timing of supply. On the second question -- the second part of your question on recession, clearly, our hospital customers are under financial pressure. We have seen that at the end of Q1 and had communicated with you at that time.

這仍然是波濤洶湧的，我們預計，當然對於第三季度甚至未來，我們將繼續在供應時間方面與這些鬥爭作鬥爭。關於第二個問題——關於經濟衰退的問題的第二部分，很明顯，我們的醫院客戶面臨財務壓力。我們在第一季度末看到了這一點，並在當時與您進行了溝通。

I think relative to where we were as Intuitive a decade ago, the size and strength of the installed base, the relative position that we have in terms of centrality to surgery and multiple disciplines and the expression of that in recurring revenue, the percentage of our business that's in recurring revenue, I think, gives us a little bit better shock absorption and predictability in terms of a large part of the revenue of the business. And gives us a few more degrees of freedom in terms of how we make our investments and time those investments relative to '08, '09.

我認為，相對於十年前我們作為 Intuitive 的情況，安裝基礎的規模和實力，我們在手術和多學科的中心地位方面的相對地位，以及在經常性收入中的表現，我們的百分比我認為，經常性收入的業務在大部分業務收入方面為我們提供了更好的減震和可預測性。並且在我們如何進行投資以及相對於 08 年和 09 年投資的時間方面給了我們更多的自由度。

We are close with our customers. I am personally in contact with many. The trends that we've been describing to you, I think, we understood pretty well the size and duration of those trends in terms of pressure, very hard for any of us to predict. And you had a follow-on?

我們與客戶關係密切。我個人接觸過很多。我認為，我們一直在向您描述的趨勢，我們非常了解這些趨勢在壓力方面的規模和持續時間，我們任何人都很難預測。你有後續嗎？

Yes, that's all fair. Again, I'm going to push my luck a little bit here. FDA seems to be requiring clinical data for new systems. We know you have a new system in development. So my question is, do you know yet if FDA is going to require clinical data for your new system before approval? And if so, what can you share?

是的，這很公平。再說一次，我要在這裡稍微碰碰運氣。 FDA 似乎需要新系統的臨床數據。我們知道您正在開發一個新系統。所以我的問題是，您是否知道 FDA 在批准之前是否會要求您的新系統提供臨床數據？如果是這樣，你可以分享什麼？

Looking at 2 things, I think let me broaden the question. Looking at the regulatory environment globally and in particular, in the United States and Europe, we have seen a trend in medical device and in robotic-assisted surgery for increasing data requirements. Sometimes those are trials, sometimes there are other kind of data. That trend has continued, and it's impacting all of us in the market, including Intuitive.

看兩件事，我想讓我擴大這個問題。縱觀全球監管環境，特別是美國和歐洲的監管環境，我們看到醫療設備和機器人輔助手術對數據需求不斷增加的趨勢。有時這些是試驗，有時還有其他類型的數據。這種趨勢一直在持續，它影響著市場上的所有人，包括 Intuitive。

You can expect that we will improve the Gen 4 product that's out there. We can get good ideas and technologies into our existing customer base hands and improve their utility, we will do that. We are, of course, working on next generations. And as I've said before, generations after that, without answering your question specifically, the deeper the technologic opportunities and the clinical impact, the more likely you have a deeper validation work to do.

您可以期待我們將改進現有的第 4 代產品。我們可以將好的想法和技術帶到我們現有的客戶群手中並提高他們的效用，我們會這樣做。當然，我們正在為下一代工作。正如我之前所說，在那之後的幾代人中，如果沒有具體回答您的問題，技術機會和臨床影響越深，您就越有可能進行更深入的驗證工作。

And we're not afraid of that work. I'd rather do things that are really clinically meaningful for the customer. And if we have to do the work, then we'll do the work. I will say for everybody on the call, it's clear that relative to a decade ago, the investment trough and the time lines for new systems have both increased. The time lines have increased because of the changing regulatory environments in several countries. And as a result, the amount of investment that has to go into that has also changed. It's also increased.

我們並不害怕這項工作。我寧願做對客戶真正有臨床意義的事情。如果我們必須做這項工作，那麼我們就會做這項工作。我要對電話會議上的每個人說，很明顯，相對於十年前，投資低谷和新系統的時間線都增加了。由於幾個國家不斷變化的監管環境，時間線有所增加。結果，必須投入的投資金額也發生了變化。它也增加了。

I think, and this is a prediction that it will also extend the useful life of products that we design. So it's taking a little longer to get to market than it used to, maybe more than a little, it's costing us more to get there. But that change in environment also means that really well-designed systems probably have longer useful life in the field. And I think we're starting to see that early evidence of that as well. So thank you for the question, Larry.

我認為，這是一個預測，它還將延長我們設計的產品的使用壽命。因此，與以往相比，進入市場需要更長的時間，也許不止一點點，我們為此付出了更多的成本。但環境的這種變化也意味著設計良好的系統可能在現場有更長的使用壽命。我認為我們也開始看到這方面的早期證據。所以謝謝你的問題，拉里。

And next, we'll go to the line of Amit Hazan representing Goldman Sachs.

接下來，我們將轉到代表高盛的 Amit Hazan。

Maybe to come back to the supply chain question. I want to maybe ask it, different lens as kind of a bigger picture here, just given all the challenges you've gone through in the past 1.5 years or so. Do you have plans that change strategically in terms of evolving towards maybe regionalization or domestication of the supply chain? And how do we think about that and incremental costs that might come with that, if that's the plan? Or do you just plan to kind of ride this out and expect a more normal environment next year?

也許回到供應鏈問題。我想問一下，考慮到你在過去 1.5 年左右所經歷的所有挑戰，不同的鏡頭在這裡是一種更大的圖景。您是否有計劃在供應鏈的區域化或本土化方面發生戰略性變化？如果這是計劃，我們如何考慮這一點以及隨之而來的增量成本？還是您只是打算安然度過這一階段並期待明年的環境更加正常？

I'll start. And Jamie, you can lean in. First, I want to acknowledge our operating teams and the supply chain teams. They have done a spectacular job in the number of components that we manage in a robotic surgery system, both on the capital side and on the instruments and accessories side and the management of those supply chains is remarkable, perhaps bigger than most people expect relative to the size of our company. They have been really good at being proactive and thoughtful about supply chain, robustness about strategic reserves and about the ability to pivot into alternative components when we need to.

我會開始的。 Jamie，你可以參與進來。首先，我要感謝我們的運營團隊和供應鏈團隊。他們在我們在機器人手術系統中管理的組件數量方面做得非常出色，無論是在資本方面還是在儀器和配件方面，這些供應鏈的管理非常出色，可能比大多數人預期的要大我們公司的規模。他們非常善於在供應鏈、戰略儲備的穩健性以及在我們需要時轉向替代組件的能力方面積極主動和深思熟慮。

And that has really been a spectacular performance. That's a long way of saying that they have been proactive. They will continue to be forward-looking and design for supply chain robustness. What that looks like depends a lot on the underlying product, whether it's creating second sources or using alternatives or thinking about regional deployment. We have been working through regional deployment prior to the pandemic, and we've done that work as we've gone on. That does incur some costs. We're thoughtful about it. And Jamie, why don't you provide your perspective?

這真是一場壯觀的表演。可以說他們一直是積極主動的。他們將繼續具有前瞻性，並為供應鏈的穩健性而設計。這看起來在很大程度上取決於底層產品，無論是創建第二個來源還是使用替代品或考慮區域部署。在大流行之前，我們一直在進行區域部署，並且我們一直在進行這項工作。這確實會產生一些成本。我們對此深思熟慮。傑米，你為什麼不提供你的觀點？

From a strategic perspective or a long-term perspective, setting aside the current supply chain challenges, some of the things that we consider in our own long-term planning is the size of our business as it grows over time in the various regions that we serve, where you might locate, redundant capacity or incremental capacity. And in terms of the economic equation, you're trading the potential cost of redundancy with savings on freight and logistics to the extent that you can supply them in region.

從戰略角度或長期角度來看，撇開當前的供應鏈挑戰不談，我們在自己的長期規劃中考慮的一些事情是我們的業務規模，因為它在我們的各個地區隨著時間的推移而增長為您可能找到的位置提供冗餘容量或增量容量。就經濟等式而言，您可以在可以在區域內供應它們的範圍內，將冗餘的潛在成本與運費和物流的節省進行交易。

That economic analysis is relatively straightforward. And really, you're just looking for the degree of redundancy you want and when does the regional businesses get big enough to warrant the economics. But certainly, what you described is something that we're looking at carefully and have been.

這種經濟分析相對簡單。實際上，您只是在尋找您想要的冗餘程度以及區域業務何時變得足夠大以保證經濟性。但可以肯定的是，您所描述的是我們正在仔細研究並且一直在關注的東西。

And maybe just to hit on just earnings and going into the future with the components that you give us, it seems pretty clear this year, we're probably not going to get earnings growth. You had some interesting comments. It sounds like R&D, you're going to keep spending and you believe what you're doing organically that makes sense. And sir, if you have more comments on SG&A, but just thinking through, okay, no earnings this year, in terms of your commitment to shareholders, is it okay for you not to grow earnings next year, too? Would that become a bigger focus for you just given how this year has gone? How do you think about earnings growth after kind of what this year is going to end up looking like?

也許只是為了獲得收益並使用您提供給我們的組件進入未來，今年似乎很清楚，我們可能不會獲得收益增長。你有一些有趣的評論。這聽起來像是研發，你會繼續花錢，你相信你有機地做的事情是有道理的。先生，如果您對 SG&A 有更多評論，但只是想一想，好吧，就您對股東的承諾而言，今年沒有收益，您明年也可以不增加收益嗎？考慮到今年的情況，這會成為你更大的關注點嗎？在經歷了今年的最終結果之後，您如何看待收益增長？

Yes. So we're not going to get specific about '23 at this point. You'll obviously see us provide our outlook on the January call. What we're doing with respect to R&D currently is investing in multiyear projects and investments. You see that in our newer platforms, Ion and SP. We have obviously investments in digital, many of which are at an early stage. And we do continue to invest in, in the fourth generation ecosystem. And we look at the returns on those investments carefully and have confidence in them.

是的。所以我們現在不打算具體介紹'23。您顯然會看到我們提供了對 1 月份電話會議的展望。我們目前在研發方面所做的是投資多年項目和投資。您可以在我們的新平台 Ion 和 SP 中看到這一點。我們顯然在數字方面進行了投資，其中許多還處於早期階段。我們確實繼續投資於第四代生態系統。我們仔細研究了這些投資的回報，並對它們充滿信心。

But in part because of the regulatory time lines that Gary described, they are multiyear investments and we think that the returns there are quite attractive. And so that's why you see, for example, if you look at the first half, our R&D grew 30% relative to the overall growth of about 25% for OpEx. But if you take a multiyear view, given the growth opportunities that we see, you'd expect us to grow earnings over time.

但部分由於加里描述的監管時間表，它們是多年投資，我們認為那裡的回報非常有吸引力。這就是為什麼你會看到，例如，如果你看上半年，我們的研發增長了 30%，而運營支出的總體增長約為 25%。但是，如果您從多年的角度來看，鑑於我們看到的增長機會，您會期望我們隨著時間的推移增加收益。

I'm not going to say whether that's '23 yet or not. And with respect to operating margins, specifically, what we've said is we look to be at the high end of our medtech peer set. And by medtech, that means high-growth companies that have growth opportunities as we see that we do.

我不會說那是否是 23 年。具體而言，就營業利潤率而言，我們所說的是我們希望處於醫療技術同行的高端。而對於醫療技術，這意味著高增長公司擁有我們所看到的增長機會。

I'll speak for a second on SG&A. We do have some infrastructure that is either needs to be built out to support the growth, particularly in manufacturing or we have some processes in IT and other parts of the business where we are long live on our pavement and there's some repaving or pot holes to fix that we will finish. We do expect to see highly targeted spending in that area going forward. And as we retire some of that project spend, we'll be thoughtful about where we go next. So we'll start to see some of that expense start to titrate into next year.

我將就 SG&A 談一談。我們確實有一些基礎設施需要建造以支持增長，特別是在製造業，或者我們在 IT 和業務的其他部分有一些流程，我們在人行道上長期存在，並且有一些重鋪或坑洞修復我們將完成的問題。我們確實希望在該領域看到高度針對性的支出。當我們收回部分項目支出時，我們會考慮下一步的發展方向。因此，我們將開始看到其中一些費用開始逐漸減少到明年。

Your next question comes from the line of Travis Steed with Bank of America.

您的下一個問題來自美國銀行的 Travis Steed。

Gary, I'd love a little more color just on the overall hospital capital environment. Are you seeing hospitals just being more cautious on the near term? Or do you think we're in for a longer duration CapEx slowdown? I'm curious how you think the slowdown could range in terms of outcomes. If it's like '08 '09 or '13, '14 or 2020. And also like leases ticked up to 42% this quarter. I'm curious where you think that could peak in the slower CapEx environment?

加里，我希望在整個醫院資本環境上多一點色彩。您是否看到醫院在短期內變得更加謹慎？還是您認為我們的資本支出放緩時間會更長？我很好奇你認為經濟放緩在結果方面的影響範圍如何。如果是 08 年 09 年或 13 年、14 年或 2020 年。而且本季度的租金上漲了 42%。我很好奇您認為在較慢的資本支出環境中可能會在哪里達到頂峰？

Yes. On the -- hard to predict the depths and duration of hospital pressure, so I won't. I will talk about what the -- I think what the inputs are, what they're faced with. Clearly, they're constrained on labor and the labor costs because of that constraint have gone up, that's not something that will resolve quickly. They're also facing inflationary pressure in some of their materials that they purchase. And they don't have enormous flexibility to change pricing on their side. So I would expect profitability constraint on the hospital side to be present.

是的。關於——很難預測醫院壓力的深度和持續時間，所以我不會。我將討論什麼——我認為輸入是什麼，他們面臨什麼。顯然，他們受到勞動力的限制，並且由於這種限製而導致的勞動力成本上升，這不是很快就能解決的問題。他們購買的一些材料也面臨通脹壓力。而且他們沒有很大的靈活性來改變他們的定價。所以我預計醫院方面的盈利能力限制會存在。

In light of that, one of their first tools in their toolkit is to try to get greater productivity out of existing assets and capital, and Intuitive will help them. If there is more productivity to get out of the products they already owned, we will help them do that. I still think there are hospitals out there that are going to be strategic, that are in better financial condition.

鑑於此，他們工具包中的第一個工具是嘗試從現有資產和資本中獲得更高的生產力，而 Intuitive 將幫助他們。如果從他們已經擁有的產品中獲得更高的生產力，我們將幫助他們做到這一點。我仍然認為有些醫院將具有戰略意義，財務狀況更好。

And if they want to build a new capacity and a new product line, SP or Ion or to branch out into a new region, then they'll do that and we'll help them do that as well. I don't think this is a 1- or 2-quarter resolution. It's certainly going to be something longer than that. With regard to change in lease and how do we think about leases going forward, Jamie, I'll ask you to take that.

如果他們想建立新的產能和新的產品線，SP 或 Ion，或者擴展到新的地區，那麼他們會這樣做，我們也會幫助他們這樣做。我不認為這是一個 1 或 2 個季度的決議。它肯定會比這更長。關於租約的變化以及我們如何看待未來的租約，傑米，我會請你接受。

Yes. If I split between U.S. and OUS, what you've seen in the U.S. is relative maturity in understanding and acceptance use of our leasing program. It's been ticking up slowly over time. While it will fluctuate quarter-to-quarter based on customer preference, I do think that will slowly continue to tick up just based on what we hear from customers. In OUS, where we offer leasing, which is not in every market, we're at an earlier stage. And so you're seeing growing understanding and acceptance of leasing as an option as they acquire capital. And so I'd expect that to continue to climb over time.

是的。如果我在美國和 OUS 之間進行區分，那麼您在美國看到的是在理解和接受我們的租賃計劃使用方面相對成熟。隨著時間的推移，它一直在緩慢上升。雖然它會根據客戶偏好逐季度波動，但我確實認為，僅根據我們從客戶那裡聽到的情況，這種情況將繼續緩慢上升。在 OUS，我們提供租賃服務，並非在每個市場都提供，我們處於早期階段。因此，當他們獲得資本時，您會看到越來越多地理解和接受租賃作為一種選擇。所以我預計隨著時間的推移會繼續攀升。

Great. And I had one other question, Gary. Listened to your talk at SRS a few weeks ago, and you mentioned the time it takes to get new products to market is a couple of years longer. I think you said 6 to 8 years before, now 8 to 10 years. Love to kind of get in a little more detail on that assumption that you went through there. And I kind of think as I guess some it's mostly regulatory, but kind of dig into the comment a bit more and see how that's changed your strategic thinking in general of how you think about innovation and your product cycles at the moment.

偉大的。我還有另一個問題，加里。幾週前聽了您在 SRS 的演講，您提到將新產品推向市場所需的時間要長幾年。我想你說的是 6 到 8 年前，現在是 8 到 10 年。喜歡更詳細地了解您所經歷的假設。而且我有點認為，我猜它主要是監管，但有點深入評論評論，看看這如何改變了你目前對創新和產品週期的看法的總體戰略思維。

Yes. It was kind of a directional comment, more about averages than about a particular product line. So I discourage anybody looking at a particular product line and try to infer from it. We have a basket of things we do and on average, it's gotten longer. Strategically, I think there are a couple of things that strengthen the business that versus a decade ago that help us and give us more flexibility, more freedom. And that is both the deep penetration we have in the market, the large size of the customer base in terms of active users.

是的。這是一種定向評論，更多的是關於平均值而不是特定產品線。因此，我不鼓勵任何關注特定產品線並嘗試從中推斷的人。我們有一籃子要做的事情，平均而言，它變得更長了。從戰略上講，我認為與十年前相比，有幾件事可以加強業務，幫助我們並給予我們更大的靈活性和更多的自由。這既是我們在市場上的深度滲透，也是活躍用戶方面的龐大客戶群。

If we can get them a technology in increments, we're not as dependent on capital revenue as years passed. I think the recurring revenue side is a strength for us. If that increases productivity for the hospital, that's great. It turns out that, that gives them better financial returns on the investments they made, but also our economic profile is stronger in repeat use utilization than it is in capital change.

如果我們可以讓他們逐步獲得一項技術，我們就不會像過去幾年那樣依賴資本收入。我認為經常性收入方面對我們來說是一個優勢。如果這能提高醫院的生產力，那就太好了。事實證明，這為他們的投資帶來了更好的財務回報，而且我們的經濟狀況在重複使用利用率方面比在資本變化方面更強。

So what that means to us is bring capital change when it really is differentiated, when it really brings incremental clinical value or new market access to our customers. And that's what we're focused on. With regard to the regulatory side, our goal is to be really good at it to get the right data we need at the right time to -- right the first time and take care of it. And those types of requirements ebb and flow over time, and we're in a particular state where the requirements are quite high, and we'll deal with it.

因此，這對我們來說意味著當它真正與眾不同時，當它真正為我們的客戶帶來增加的臨床價值或新的市場准入時，就會帶來資本變革。這就是我們所關注的。關於監管方面，我們的目標是真正擅長在正確的時間獲得我們需要的正確數據——第一次就正確並妥善處理。這些類型的需求會隨著時間的推移而起起落落，而我們處於一個要求相當高的特殊狀態，我們會處理它。

And we'll go to the line of Robbie Marcus, representing JPMorgan.

我們將轉到代表摩根大通的羅比·馬庫斯（Robbie Marcus）的路線。

Great. Maybe to start, a lot of your comments, it feels like it's a U.S. comment in terms of the capital equipment. I want to get a sense, is there any difference in geography just given the hospitals, most of them outside the U.S., are dictated by single-payer country networks? And then I'll just ask a follow-up as well. Pretty good OUS procedure number. How do we think about how much of an impact the shutdowns in China had? And how should we be thinking about the ramp in second half on China just given that the country is still not on a strong pathway to a reopening?

偉大的。也許首先，你的很多評論，感覺就像是美國在資本設備方面的評論。我想了解一下，考慮到醫院（其中大多數在美國以外）是由單一支付國家網絡決定的，地理位置有什麼不同嗎？然後我也會問一個後續問題。相當不錯的 OUS 程序編號。我們如何看待中國停工的影響有多大？鑑於該國仍未走上通往重新開放的強勁道路，我們應該如何考慮下半年中國的坡道？

Yes. Robbie, on that first question, it's a good one, and I appreciate it. Clearly, the utilization of systems and the posture of hospital acquisition relative to systems differs by country based on the maturity of our markets and the depth of penetration of da Vinci. We tried to call that out a little bit in the script. Jamie, I don't know if there's additional color you'd like to apply.

是的。羅比，關於第一個問題，這是一個很好的問題，我很感激。顯然，根據我們市場的成熟度和達芬奇的滲透深度，系統的使用和醫院採購相對於系統的姿態因國家而異。我們試圖在腳本中稍微指出這一點。傑米，我不知道你是否還想塗上其他顏色。

Yes, I'd just say the softness in the U.S. capital pipeline is clear, and it's been clear for 2 quarters. What you saw in placements in Q2 was actually OUS placements grew as compared to a year ago, we haven't seen any clear and specific indications on capital weakness that I call out. Obviously, China had a challenging quarter with respect to procedures. But you look at the macro, you look at what's happening in Europe, you could imagine that, that might be a challenge as you look forward. But nothing that I call out at this point.

是的，我只想說美國資本管道的疲軟是顯而易見的，而且已經有兩個季度了。您在第二季度的配售中看到的實際上是 OUS 配售與一年前相比有所增長，我們還沒有看到任何明確和具體的資本弱點跡象。顯然，中國在程序方面遇到了一個充滿挑戰的季度。但是你看看宏觀，你看看歐洲正在發生的事情，你可以想像，這可能是你向前看的一個挑戰。但此時我沒有說什麼。

On -- you had asked kind of how do we expect China to proceed in procedures in the back half. Of course, that's impossible for us to predict. What I might ask, Brian, as you might just reiterate some of your comments is what's assumed in the model in terms of (inaudible)?

關於 - 你曾問過我們如何期望中國在後半部分的程序中進行。當然，這是我們無法預測的。我可能會問，Brian，因為您可能只是重申您的一些評論，是模型中假設的（聽不清）？

Yes. So we have seen, I'd say, at the end of Q2, we did see some improvement or recovery of procedures, I'd say probably closer to more normal levels over time. It's really hard to predict what's going to happen in China. I think they are our second largest market by procedure volume. It does have an impact when things do slow down, but you can see the procedure growth that we had despite the challenges in China. So I think it's probably a bit too soon to really give any color on what's going to happen there because there's just still so much variability. And frankly, we're still really early in the quarter.

是的。所以我們已經看到，我想說，在第二季度末，我們確實看到了一些程序的改進或恢復，我想說隨著時間的推移可能更接近更正常的水平。很難預測中國會發生什麼。我認為按手術量計算，它們是我們的第二大市場。當事情確實放緩時，它確實會產生影響，但你可以看到儘管在中國面臨挑戰，我們的程序仍在增長。因此，我認為現在對將要發生的事情給出任何顏色可能還為時過早，因為仍然存在很大的可變性。坦率地說，我們還處於本季度的早期階段。

And we have a question from Rick Wise, representing Stifel.

我們有代表 Stifel 的 Rick Wise 提出的問題。

Again, reflecting on history a little bit, when I think back to the end of the financial crisis to earlier last decade, obviously, there were periods of marked capital slowdown. And yes, those -- the recovery following that was in part a macro recovery, but it was also the -- in 2014, the launch of the Xi, it was a procedure volume uptake, expanded instruments. I mean there were many drivers of the recovery under the umbrella of the macro recovery.

再次回顧一下歷史，當我回想起金融危機結束到上個十年早些時候，很明顯，有一段時間資本明顯放緩。是的，那些 - 之後的複蘇部分是宏觀復甦，但也是 - 在 2014 年，Xi 的推出，這是一個程序量的增加，擴大了工具。我的意思是，在宏觀復甦的保護傘下，有許多推動復甦的因素。

As we look ahead and think about the next few years, assuming a macro recovery occurs, I was just reflecting that the mix might be different this time. But what's -- the -- on the procedure side and the system or instrument side, I mean, what are the drivers that get us back to that accelerated growth again? Is it international instruments? And yes, inevitably a new system at some point or how would you talk about the next few years and thinking about a recovery from this period?

當我們展望未來並考慮未來幾年時，假設出現宏觀復甦，我只是在思考這次的組合可能會有所不同。但是，在程序方面和系統或儀器方面是什麼，我的意思是，讓我們再次回到加速增長的驅動力是什麼？是國際文書嗎？是的，在某些時候不可避免地會出現一個新系統，或者你會如何談論未來幾年並考慮從這一時期恢復過來？

Appreciate the question. In terms of drivers of growth, first, kind of zoom out, we are in the thick part of the adoption curve in the United States in general surgery across multiple sub-procedures. And there's real room there. I don't think we're saturated. And response has been really good and our training numbers and adoption and the underlying capability of our Gen 4 products has been great. So that's one.

欣賞這個問題。就增長的驅動因素而言，首先，我們處於美國普外科多個子程序採用曲線的較厚部分。那裡有真正的空間。我不認為我們已經飽和。反應非常好，我們的培訓數量和採用率以及我們第 4 代產品的基本功能都很棒。所以這是一個。

Two, we're seeing investments that we made many years ago in rounded teams, rounded Intuitive teams in key countries pay back now. And that has been fantastic. So it starts with growth in oncology -- oncologic surgical procedures outside of urology in addition to urology, so we're seeing that. But we're also seeing the early indications of adoption in benign surgery in OUS markets, which is, frankly, an exciting green shoot in the sense that, that could follow a pathway that mirrors what we saw in the U.S.

第二，我們看到我們多年前在圓形團隊中所做的投資，在關鍵國家的圓形直覺團隊現在得到了回報。這太棒了。所以它始於腫瘤學的發展——除了泌尿外科之外的泌尿外科腫瘤外科手術，所以我們看到了這一點。但我們也看到了在 OUS 市場採用良性手術的早期跡象，坦率地說，這是一個令人興奮的綠芽，從某種意義上說，這可能遵循我們在美國看到的路徑。

So I think there's lots of opportunity there, and that has to do with bringing our instruments, our accessories, our ecosystem, our training capabilities, our data capabilities into our priority country markets over time. So we've got that. We have outstanding innovations that are coming to market. Ion is doing really well in the U.S. Ion will go deeper into other applications. We're trying to bring it to Europe in that process, we'll bring it to Asia over time.

所以我認為那裡有很多機會，這與隨著時間的推移將我們的儀器、我們的配件、我們的生態系統、我們的培訓能力、我們的數據能力帶入我們的優先國家市場有關。所以我們得到了那個。我們有即將上市的傑出創新。 Ion 在美國的表現非常好。Ion 將更深入地進入其他應用領域。我們正試圖在這個過程中把它帶到歐洲，隨著時間的推移我們會把它帶到亞洲。

SP, SP is having great success in Korea. We're bringing it to Japan. We're working on additional indications for the United States. SP has differentiated capability. And as those indications get added and it's hard work, I think it will bring incremental procedures to our customers and then to us over time. And those are procedures that are either rarely done with da Vinci or not done with da Vinci at all. And I think that's another leg of opportunity.

SP，SP在韓國取得了巨大的成功。我們要把它帶到日本。我們正在研究針對美國的其他適應症。 SP具有差異化能力。隨著這些跡象的增加並且這是一項艱苦的工作，我認為它將為我們的客戶帶來增量程序，然後隨著時間的推移給我們帶來。這些程序要么很少用達芬奇完成，要么根本不用達芬奇完成。我認為這是另一個機會。

And how many years does it take? Well, they will layer out. Those things will layer out over time. In terms of regional performance, we have those opportunities in front of us right now. In terms of things like SP and Ion, SP is one of the more mature technologies and new platform. I think its economics are looking increasingly good for Intuitive and as they continue to knock down additional clinical indications, I think that will add strength.

以及需要多少年？好吧，他們會分層。這些東西會隨著時間的推移而分層。就區域表現而言，我們現在擁有這些機會。就 SP 和 Ion 這樣的東西而言，SP 是比較成熟的技術和新平台之一。我認為 Intuitive 的經濟學看起來越來越好，隨著他們繼續減少其他臨床適應症，我認為這將增加實力。

Ion has been growing like a weed. It's less mature in terms of its financial profile, but we're working hard on it. And so I think those things will contribute as well. So I think we have irons in the fire that we have confidence in.

離子一直像雜草一樣生長。它的財務狀況不太成熟，但我們正在努力。所以我認為這些東西也會有所貢獻。所以我認為我們有信心的鐵桿。

Okay. And just one last quick one for me. It's a little bit of a fishing expedition kind of question. Just reflecting on your comments about partnering with hospitals. One aspect is financially and with leases, et cetera. But I know you have many initiatives underway in terms of data collection and management. Any update in terms of your initiatives there? And is there anything on that side of the house we should be paying attention to?

好的。對我來說只有最後一個快速的。這有點像釣魚探險的問題。只是反映您對與醫院合作的評論。一方面是財務和租賃等。但我知道你們在數據收集和管理方面正在進行許多舉措。你的舉措有什麼更新嗎？房子的那一側有什麼我們應該注意的嗎？

Thanks, Rick. On the basics, in our more mature da Vinci markets, our data facility and in terms of the ability to collect, analyze and share insight with our hospitals has been really good. And they are the things that allow them to compare the efficacy and efficiency of their da Vinci program. Relative to others in their own hospital group, relative to national and international norms, it allows them to make decisions about where capacity ought to go and where there are opportunities for improvement within their system.

謝謝，瑞克。在基礎方面，在我們更成熟的達芬奇市場中，我們的數據設施以及收集、分析和與我們醫院分享洞察力的能力非常好。它們是讓他們比較達芬奇計劃的功效和效率的東西。相對於他們自己醫院集團中的其他人，相對於國家和國際規範，它允許他們決定能力應該去哪里以及他們的系統內哪裡有改進的機會。

We use that routinely. It is not a new idea. It's starting to become really baked into all the workflows and processes. We're automating a lot of that capability. So that's been fabulous. At the other end of the spectrum, we are engaged with a hard core health care researchers looking at what AI and our data sets can bring in terms of improved outcomes, personalized training, faster time to competency. And the excitement level there is quite high and we're continuing to invest down that pathway.

我們經常使用它。這不是一個新想法。它開始真正融入所有工作流程和流程。我們正在自動化很多這種能力。所以這太棒了。另一方面，我們與核心醫療保健研究人員合作，研究人工智能和我們的數據集在改善結果、個性化培訓、更快獲得能力方面可以帶來什麼。那裡的興奮程度非常高，我們將繼續沿著這條道路進行投資。

So in one set, it's used every day and another set, I think it's in the innovation engines and it's informing discovery. And I believe those discoveries, in a few years, will change the nature of surgery and some of the training that we do. So I think there's an opportunity on both sides.

所以在一組中，它每天都在使用，另一組，我認為它在創新引擎中，它為發現提供信息。我相信這些發現在幾年內將改變手術的性質和我們所做的一些培訓。所以我認為雙方都有機會。

Just one last question, please.

請最後一個問題。

All right. Our final question today will come from the line of Richard Newitter representing Truist.

好的。我們今天的最後一個問題將來自代表 Truist 的 Richard Newitter。

Gary, just on that last answer. Can you give us any sense as to how, if and maybe even when you might look to begin monetizing those types of -- I don't want to say new alternative service models, things that might help hospitals become more efficient. Can we expect to see that filter into new sources of revenue streams and when? And are you already exploring that? And then I have one follow-up.

加里，就最後一個答案。您能否告訴我們如何、是否甚至何時開始將這些類型的貨幣化——我不想說新的替代服務模式，這些可能有助於醫院提高效率的東西。我們能否期望看到這種過濾器進入新的收入來源？什麼時候？你已經在探索了嗎？然後我有一個後續行動。

I -- we've said this before, in our digital efforts in terms of digital tools, some of them are -- the way we do our financial analysis, some of them are value creating through efficiency and labor savings on our side or on the hospital side and the investments are really a reduction in our cost to serve. So that's one category.

我 - 我們之前已經說過，在我們在數字工具方面的數字化努力中，其中一些是 - 我們進行財務分析的方式，其中一些是通過我們身邊或身邊的效率和勞動力節省來創造價值醫院方面和投資確實降低了我們的服務成本。所以這是一類。

There's another category that is around accelerated time to competency that lowers our cost to serve through having people get through their implementation and programmatic processes more quickly. The third category is direct revenue opportunity. We have things in the field working in all 3 of those categories. So none of them is empty.

還有一個類別是關於加速能力的時間，它通過讓人們更快地完成他們的實施和程序化流程來降低我們的服務成本。第三類是直接收入機會。我們在這三個類別中都有工作。所以沒有一個是空的。

In terms of pricing and customer acceptance of our value proposition, we are out in our training opportunities in some of our augmented reality spaces and in our Intuitive Hub starting to explore those. Some of them are very, very early. Some of them are reasonably mature in terms of what our pricing and other models look like. What I would tell you is that relative to other sources of revenue, these should be accretive to our bottom line because of some of the cost savings, but they won't be huge revenue lines in the near term. I would not set the expectation that all of that turns into big time revenue.

在定價和客戶對我們的價值主張的接受度方面，我們在一些增強現實空間和我們的直覺中心開始探索這些空間的培訓機會。其中一些非常非常早。其中一些在我們的定價和其他模型方面相當成熟。我要告訴你的是，相對於其他收入來源，由於節省了一些成本，這些應該會增加我們的底線，但它們在短期內不會是巨大的收入線。我不會期望所有這些都會變成大筆收入。

Our biggest thing and our focus is to help customers, hospitals get to great, high-functioning, minimally invasive surgery programs using our products. If we do that, then they will find a way to pay us. And so far, that economic engine has worked well for them and it's worked well for us.

我們最重要的事情和我們的重點是幫助客戶和醫院使用我們的產品獲得出色的、高功能的、微創手術計劃。如果我們這樣做，他們就會想辦法付錢給我們。到目前為止，這種經濟引擎對他們來說效果很好，對我們也很有效。

Great. And just -- you guys mentioned TORS, I believe, where SP is gaining traction. You've got 20% penetration. I think you estimated -- of U.S. estimated procedures. Just remind us, how big of a category is TORS? Can you quantify that for us? And where do you think something like that could go? Or where are some of your more aggressive users in terms of their penetration already?

偉大的。只是——你們提到了 TORS，我相信，SP 正在獲得牽引力。你有 20% 的滲透率。我想你估計 - 美國估計的程序。請提醒我們，TORS 是一個多大的類別？你能為我們量化嗎？你認為這樣的事情會去哪裡？或者就滲透率而言，您的一些更具侵略性的用戶已經在哪裡了？

Yes. On the micro question, so that was malignant TORS. It's a small but high-value segment. Roughly TAM number of surgeries performed is in the 10,000 per year range. So a relatively small market. But like I said, for surgeons and patients, really high value. In terms of where it might go, I'll let Gary expand on that.

是的。在微觀問題上，這是惡性 TORS。這是一個小而高價值的細分市場。大約 TAM 進行的手術數量在每年 10,000 次範圍內。所以市場比較小。但就像我說的，對於外科醫生和患者來說，價值真的很高。至於它可能會去哪裡，我會讓 Gary 對此進行擴展。

Yes. I think that SP and narrow access surgery has opportunities to extend the kinds of procedures that are done robotically and we'll look to Korea as a guide in that they have broad clearances. And they're using it all over the body from gynecology to breast oncology and other things where they see value. And I think that as that clinical evidence comes through and as the clearances expand, you'll see incremental opportunity that is reasonable for us and, I think, exciting for our customer base. We'll detail those things further in future calls as that data starts to publish.

是的。我認為 SP 和狹窄通路手術有機會擴展機器人完成的手術種類，我們將把韓國作為指南，因為它們有廣泛的許可。他們在全身使用它，從婦科到乳腺腫瘤學以及他們認為有價值的其他事情。而且我認為隨著臨床證據的出現和許可的擴大，你會看到對我們來說是合理的增量機會，我認為這對我們的客戶群來說是令人興奮的。隨著數據開始發布，我們將在未來的電話會議中進一步詳細介紹這些內容。

That was our last question. In closing, we continue to believe there is a substantial and durable opportunity to fundamentally improve surgery and acute interventions. Our teams continue to work closely with hospitals, physicians and care teams in pursuit of what our customers have termed the quadruple lane: Better, more predictable patient outcomes, better experiences for patients, better experiences for their teams and ultimately, a lower total cost of care.

那是我們的最後一個問題。最後，我們仍然相信存在從根本上改善手術和急性干預的實質性和持久的機會。我們的團隊繼續與醫院、醫生和護理團隊密切合作，以追求我們的客戶所說的四重通道：更好、更可預測的患者結果、更好的患者體驗、更好的團隊體驗，並最終降低總成本關心。

We believe value creation in surgery and acute care is foundationally human. It follows from respect for and understanding of patients and care teams, their needs and their environment. At Intuitive, we envision a future of care that is less invasive and profoundly better where diseases are identified earlier and treated quickly so patients can get back to what matters most. Thank you for your support on this extraordinary journey. We look forward to talking with you again in 3 months.

我們相信，手術和急症護理的價值創造從根本上說是人性化的。它源於對患者和護理團隊、他們的需求和環境的尊重和理解。在 Intuitive，我們設想了一個侵入性更小、更好的護理未來，即更早發現并快速治療疾病，以便患者能夠回到最重要的事情上。感謝您對這次非凡旅程的支持。我們期待在 3 個月後再次與您交談。

Ladies and gentlemen, that does conclude our conference for today. We thank you for your participation and using the AT&T Event Services. You may now disconnect.

女士們先生們，今天的會議到此結束。我們感謝您的參與和使用 AT&T 活動服務。您現在可以斷開連接。